AMARA REYES
Dependent on policy B04M000135
Claims
2
Attributed to this person
Charged
958.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
97.60
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | AMARA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000135 |
| Date of birth | 12 Nov 1963 |
| Plan | GOLD PPO |
| Covered from | 5 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 97.60 |
| Total | 97.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000625 | 28 Jun 2026 | 470.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000626 | 3 Mar 2026 | 488.00 | MERIDIAN HEALTH PLAN | Not denied | — |